Real-World Burden and Progression of Geographic Atrophy

Journal Highlights

Chakravarthy et al. con­ducted research to better understand the progression of geographic atrophy (GA) to choroidal neovasculariza­tion (CNV) and the effect of GA on visual acuity (VA) in real-world settings. They found that the atrophy is linked to substantial visual impairment that often renders those with GA ineli­gible to drive.

For this multicenter retrospective study, an anonymized dataset was constructed from the electronic health records (EHRs) from October 2000 to February 2016 at 10 clinical sites in the United Kingdom. An algorithm was used to identify cases with a GA diagnosis. From these records, the re­searchers isolated a study population of 1,901 patients (≥50 years of age) with bilateral GA and no history of CNV. A random sample of records from each center was used to validate the defini­tions of disease and progression.

Outcomes of interest were pro­gression to blindness (VA <20 Early Treatment Diabetic Retinopathy Study letters or Snellen 20/400 in the better eye), driving ineligibility (VA ≤70 let­ters or Snellen 20/40 in the better eye), progression to CNV, loss of ≥10 letters, and mean change in VA over time. An­other goal was to identify risk factors associated with progression.

At the time of their first record of a GA diagnosis, 7.1% of patients had VA in the better eye that was at or below the threshold for legal blindness; 71.1% had VA that was too low for driving privileges. Over time, 16% patients became legally blind (median time to outcome, 6.2 years), and 67% became ineligible to drive (median time to outcome, 1.6 years). Among the partic­ipants with VA measurements at both baseline and 24 months, the mean decline in VA was 6.1 letters in the worse eye and 12.4 letters in the better eye. The rate of progression to CNV in either eye was 7.4% per patient-year. Older age and poorer VA at diagnosis were risk factors for a decline in VA to below the UK standard for driving.